Challenges and advances in offering urinary continence care in Malawi

Urinary incontinence (UI) is a highly prevalent condition with profound physical, psychological and social implications. In sub-Saharan Africa, structured pathways for vesicovaginal fistula management exist, however, services for non-fistulae related UI are almost entirely absent. Malawi is a low-income country with severe surgical workforce shortages and therefore lacks basic routine continence services. This article reports on a Urolink, Meditech and Cambridge Global Health Partnership programme to Kamuzu Central Hospital in Lilongwe in February 2025. The initiative delivered consultant surgical training, urodynamic assessments, outpatient clinics, equipment provision and teaching sessions to urology and gynaecology doctors in training. A mixed methods prospective service implementation and feasibility study was conducted over a one-week programme. Data on procedures, patient assessments, operative outcomes and teaching outcomes were collected. Clinical activity included both major reconstructive surgeries, such clam enterocystoplasty, complex fistulae repair, urethral diverticulectomy, rectus fascial sling and minor procedures including, urethral bulking, cystoscopy assessments, bladder Botox injections and urodynamic studies. Sixteen patients with UI were assessed in urogynecology clinics. Twelve registrars participated in lectures, viva sessions and live surgical teaching. Self-reported confidence improved significantly in all domains including the management of, stress UI, urodynamic assessments, neuropathic bladder and urinary diversion. Collaborative dual consultant operating reinforced the independence of the local consultants. Major challenges included theatre inefficiency, sterilisation limitations, shortages of nursing and anaesthetic staff, sociocultural stigma and late patient presentations. Despite these barriers, the program demonstrated the feasibility of introducing basic and advanced continence procedures, sustainable training models and national teaching platforms in a resource-limited setting. Progress in continence surgery in Malawi requires long-term mentorship, infrastructure strengthening, culturally adapted awareness campaigns and national policy support. Global partnerships can act as facilitators for sustainable, context-specific solutions. Short, intensive partnership can build local capacity and initiate a subspecialty service, but long-term outcomes remain unknown.